The Impact of COVID-19 on Access to HIV Prevention Services Among Opioid-Dependent Individuals

Abstract

The COVID-19 pandemic has necessitated restrictive orders and programmatic changes that may be associated with disruptions in services, including those for opioid-dependent people who inject drugs (PWID). This study aims to assess the impact of COVID-19 pandemic on access to and utilization of various HIV prevention services among PWID with opioid use disorder (OUD). We interviewed 110 PWID enrolled in medication for opioid use disorder (MOUD) treatment (e.g., methadone) between May and October, 2020 to identify if this sample experienced changed in access to the following services due to the COVID-19 pandemic: (a) HIV or sexually transmitted infection (STI) testing, (b) pre-exposure prophylaxis (PrEP) services, (c) HIV counselor or doctor appointments, and (d) clean injection equipment. A majority of the sample reported that COVID-19 had not changed their access to HIV testing or access to STI testing. Almost half of the sample reported that getting an appointment with a doctor decreased due to COVID-19. Participants reported that access to a lab or blood testing, access to injection equipment, and sessions with a case manager or counselor decreased. One-fourth of the 32 participants who were taking PrEP before the onset of COVID-19 reported that they had trouble getting their PrEP prescription due to COVID-19, and some reported that they had difficulty getting the PrEP prescription filled at their pharmacy. Our results indicate that PWID did not experience reduced access to HIV or STI testing, but difficulties in obtaining appointments with HIV counselors or doctors and limited access to PrEP were presented. Innovative strategies are needed to reduce the adverse effects of COVID-19 on HIV prevention among PWID.

Illicit Substance Use and the COVID-19 Pandemic in the United States: A Scoping Review and Characterization of Research Evidence in Unprecedented Times

“…The proportion of patients reporting an increase in substance use was shown to be much higher among those with higher SUD severity [ 25 ]. Mistler et al [ 26 ] compared the impacts of the pandemic on changes in substance use frequency in a sample of patients recruited from a methadone clinic between May and October, 2020. Although most survey respondents reported no change in their use of non-prescription drugs, a higher proportion of respondents in the racial-ethnic minority group (23%) reported a decrease in non-prescription drug use compared to their White counterparts (4.5%) [ 26 ].…”

“…There is scant evidence regarding changes in interpersonal aspects or contexts of substance use. Mistler et al [ 26 ] found a majority of all participants in the study reporting no change in the sharing of drugs or equipment, with 12.7% reporting a decrease in drugs or equipment sharing and none reporting an increase in such behavior. A majority of participants also reported no changes in condomless sex or in seeking transactional sex [ 26 ].…”

Impact of the COVID-19 pandemic on HIV testing rates across four geographically diverse urban centres in the United States: An observational study

“…Individuals on methadone maintenance reported no change in or access to testing. 25 Also, an increase in HIV testing was found among hospitalized individuals who use drugs. 26 However, these are unique populations accessing treatment in specialized settings.…”

Examining the impact of the first wave of COVID-19 and associated control measures on interventions to prevent blood-borne viruses among people who inject drugs in Scotland: an interrupted time series study

“…Studies to date assessing the impact of COVID-19 on services for PWID have largely relied on self-reported data or focussed on regional areas ( Bartholomew et al, 2020 , Brothers et al, 2021 , Croxford et al, 2021 , Genberg et al, 2021 , Glick et al, 2020 , Mistler et al, 2021 , Whitfield et al, 2020 ). Although these studies have yielded important insights, a recent systematic review reported that current evidence was limited and further research is required to understand the impact of COVID-19 on interventions for PWID ( Munro et al, 2021 ).…”